Abstract
Background
Among men who have sex with men (MSM), lymphogranuloma venereum (LGV) has been associated with proctocolitis that can lead to chronic complications and requires a longer course of ...antibiotic therapy than is recommended for infections due to other serovars of Chlamydia trachomatis (CT). We describe the prevalence and clinical features of LGV among Nigerian MSM diagnosed with anorectal CT.
Methods
MSM were recruited into the ongoing RV368 cohort in Lagos, Nigeria, using respondent-driven sampling. Participants were screened for HIV and bacterial sexually transmitted infections (STIs) every three months for up to 18 months. HIV was diagnosed using a parallel algorithm of rapid tests on fingerstick blood samples. PCR testing for Neisseria gonorrheae and CTwas performed on voided urine, oropharyngeal swab, and rectal swab specimens. For this analysis, prevalent and incident cases of rectal CT infection underwent additional testing to identify LGV serovars utilizing novel real-time PCR assays specific for the L serovars of CT Chlamydia trachomatis.
Results
From 28 April 2014–19 July 2016, 420 men underwent screening for rectal STIs, including 66 (15.7%) who had prevalent rectal infection with CT. An additional 68 participants developed incident infections during 208 person-years of follow-up. Of 134 eligible rectal swab specimens, 128 underwent further testing for LGV serovars. Seven (5.5%) of the tested samples were identified as LGV serovars of CT. None of the seven participants with LGV reported any symptoms such as fever or rectal pain. Two of the participants with LGV were simultaneously co-infected with rectal gonorrhea. HIV co-infection was common among participants with both LGV and non-LGV serovars of CT (71% and 77%, respectively, P = 0.74).
Conclusion
LGV was uncommon but present among Nigerian MSM in this study. LGV needs to be considered even in asymptomatic cases, particularly if anorectal CT infection fails to respond to the usual course of therapy. Consistent screening for L serovars of CT, or empiric treatment for LGV in cases with a high suspicion for this diagnosis, could potentially improve patient outcomes and decrease transmission.
Disclosures
All authors: No reported disclosures.
HIV infection has evolved from a consistently fatal diagnosis into a chronic condition that requires lifelong medication and care. These do not come cheaply. In 2015, the United States government is ...expected to spend $17.5 billion on health care services and treatment for persons living with HIV (PLWH). PLWH are living longer than they were earlier in the epidemic and beginning to experience age-related complications of comorbidities, such as viral hepatitis. Chronic co-infection with hepatitis B virus and/or hepatitis C virus is common among PLWH and plays an increasingly important role in the morbidity and mortality observed in this population. Understanding its impact on healthcare utilization can help to inform the allocation of limited healthcare resources, improve the cost-effectiveness of HIV care, and guide clinical decision-making. Understanding factors associated with healthcare utilization and costs has become especially important as the Patient Protection and Affordable Care Act is poised to dramatically alter the way healthcare is delivered in the United States. Optimism about improved access to care as a result of the ACA is mirrored by newfound optimism about the possibility of someday developing interventions to achieve a functional cure of HIV, or HIV remission. Elite controllers are a unique and rare subset of PLWH that demonstrate spontaneous virologic control without a need for antiretroviral therapy. In these patients, investigation of healthcare utilization provides insight into the clinical outcomes of elite control that may then inform not only our understanding of costs of care associated with elite control, but also the wisdom of trying to induce a state similar to elite control as a means of achieving HIV remission. The first study investigates the potential role of hepatitis co-infection as a risk factor for hospitalization among adult patients receiving longitudinal HIV care at nine clinical care sites. In 2010, a total of 2,793 hospitalizations were observed among 12,819 patients. In this study, PLWH who were co-infected with hepatitis B and/or hepatitis C had hospitalization rates that were about 50% higher than those seen among persons with HIV mono-infection, after adjusting for factors such as age, CD4 count and HIV viral load. Hospitalization rates for non-AIDS-defining infections were almost twice as high among PLWH with any hepatitis co-infection as compared to those with HIV mono-infection. Hepatitis B co-infection was associated with more hospitalizations for gastrointestinal/liver disease and hepatitis C co-infection was associated with more hospitalizations for psychiatric illnesses. The second study investigates the associations between hepatitis co-infection and utilization of primary HIV care, mental health, and hospital services at four sites from 2006-2011. Outpatient HIV visits did not differ by hepatitis serostatus and decreased over time, likely reflecting evolving professional society guidelines that recommend less frequent monitoring for patients with well-controlled HIV. Mental health visits were more common among HIV/HCV co-infected persons than among HIV mono-infected persons, emphasizing the important role of psychiatric disease in this population. The third study investigates hospitalization rates among elite controllers as compared to persons with medically controlled HIV at 11 sites from 2005-2011. With 149 elite controllers, the data from this study represent one of the largest published cohorts. After adjustment for demographic and clinical factors, elite control was associated with higher rates of all-cause, cardiovascular and psychiatric hospitalization than was medical control. Hospitalizations for cardiovascular disease were disproportionately common among elite controllers. These findings represent some of the first data on clinical outcomes in this population and are consistent with prior studies demonstrating high rates of inflammation and a high burden of apparent cardiovascular disease on radiographic screening. Care providers may consider these findings when deciding whether or not to initiate ART in patients with elite control. These data also suggest that elite control may not be an ideal model for the functional cure of HIV, since patients treated with ART appear to have better outcomes in terms of hospitalization. These studies have each been published in medical journals and are reprinted here with permission. They provide insights that can guide the clinical care of PLWH who are co-infected with hepatitis or who demonstrate elite control. They also improve our understanding of factors related to healthcare utilization and, therefore, costs of HIV care. At a time when access to care is expanding, it is essential to understand and manage costs of care. At a time when functional cure of HIV has become a realistic goal, it is essential to understand precisely the goal we wish to achieve. (Abstract shortened by ProQuest.)
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